IntroductionDisciplinary procedures can have serious consequences for the health, personal life and professional functioning of doctors. Until recently, specific disciplinary measures (reprimands) were publicly disclosed in the Netherlands. The perceived additional impact of disclosing reprimands on the professional and personal life of doctors is unclear.MethodsAll doctors who received a disciplinary measure from the Dutch Disciplinary Board between July 2012 and August 2016 were invited to partake in a 60-item questionnaire concerning the respondents’ characteristics, the complaint, experience with the procedure and perceived impact of the procedure on health and professional functioning as reported by doctors themselves. The response rate was 43% (n=210). 21.4% received a reprimand (disclosed); the remainder received a warning (not disclosed). Differences between the two groups were calculated.ResultsRespondents with a reprimand reported significantly more negative experiences and impact on health and work than respondents with a warning. 37.8% of the doctors said their health was very good. A small percentage reported moderate-to-severe depressive complaints (3.6%), moderate-to-severe anxiety disorder (2%) or indications of burnout (10.8%). The majority reported changes in their professional practices associated with ‘defensive medicine’, such as doing more supplementary research (41%) and complying more with patients’ wishes (35%).ConclusionThe Dutch disciplinary procedure has strong negative side effects, that disclosing measures seems to increase. Dutch disciplinary law aims to contribute to the quality of professional practice. A safe environment is a basic condition for quality improvement and therefore, disclosure of disciplinary measures should be carefully considered. Disclosure of disciplinary measures has always been controversial and the results of this study has rekindled this debate. Recently, a majority in the Dutch House of Representatives has voted against disclosure of reprimands, leaving disclosure of reprimands a discretion of the disciplinary board when deemed appropriate or necessary.

IntroductionDisciplinary procedures can have a negative impact on the professional functioning of medical doctors. In this questionnaire study, doctors’ experience with open culture and support during a disciplinary procedure is studied to determine whether open culture and support are associated with perceived changes in the professional practice of doctors.MethodsAll doctors who received a warning or a reprimand from the Dutch Medical Disciplinary Board between July 2012 and August 2016 were invited to fill in a 60-item questionnaire concerning open culture, perceived support during the disciplinary procedure and the impact of the procedure on professional functioning as reported by doctors themselves. The response rate was 43% (n=294).ResultsA majority of doctors perceive their work environment as a safe environment in which to talk about and report incidents (71.2% agreed). Respondents felt supported by a lawyer or legal representative and colleagues (92.8% and 89.2%, respectively). The disciplinary procedure had effects on professional practice. Legal support and support from a professional confidant and a professional association were associated with fewer perceived changes to professional practice.ConclusionOur study shows that doctors who had been disciplined perceive their working environment as open. Doctors felt supported by lawyers and/or legal representatives and colleagues. Legal support was associated with less of a perceived impact on doctors’ professional practice.

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is onderzoeker aan het Amsterdam Centre for Comprehensive Law (ACCL), verbonden aan de afdeling Privaatrecht van de Vrije Universiteit Amsterdam. Prof. mr. A.J. Akkermans is hoogleraar privaatrecht en geeft leiding aan het ACCL aan de Vrije Universiteit Amsterdam. Prof. dr. ir. R. Friele is adjunct-directeur van het NIVEL in Utrecht. Prof. mr. J. Legemaate is hoogleraar gezondheidsrecht aan de UvA/AMC.

INTRODUCTIONIn the Netherlands, concerns about the negative experiences of patients with legal procedures following adverse medical events have led to potentially profound changes in the field of procedural complaint-and compensation law. This report offers insight into the Dutch legal framework of compensation for damage caused by healthcare. We start by presenting the traditional framework in part A: The Dutch landscape of medical liability. Having laid the groundwork, we try to explain the innovations that have recently been introduced, in part B: Efforts for reform. We elaborate on the problems patients experience when they claim for compensation, the impact legal procedures can have on both patients and healthcare professionals, the recent changes in legislation trying to address these problems, and how these changes force both healthcare and legal professionals to adapt to a new reality. A.1. The legal relationship between healthcare professional and the patientThe Dutch system for compensation of damage arising from health care is fault based. The rights of patients and the corresponding duties of healthcare professionals are laid down in the Medical Treatment Contracts Act (WGBO) which is part of the Dutch Civil Code (DCC), and the Healthcare Quality, Complaints and Disputes Act (WKKGZ). The WGBO is an act on healthcare professionals' duties concerning individual patient care, the WKKGZ sets out obligations on complaint management and quality of care, including the out of court resolution of claims for compensation.The relationship between the healthcare professional and the patient is a specific contract, the medical treatment contract, for which binding rules are given in the WGBO, 1 such as the general obligation of the health care professional to observe the standards of good care and to act in conformity  Berber Laarman LLM (https://research.vu.nl/en/persons/berber-laarman) is researcher at the Amsterdam Centre for Comprehensive Law (ACCL) of Vrije Universiteit Amsterdam, the Netherlands and coordinating researcher of OPEN, a learning network of hospitals on the open and fair resolution of complaints and claims in health care (www.openindezorg.nl). OPEN is funded by the Victim Support Fund (Fonds Slachtofferhulp). Prof. dr. Arno Akkermans (https://research.vu.nl/en/persons/arnoakkermans) is professor of law at Vrije Universiteit Amsterdam and director of the ACCL (www.rechten.vu.nl/en/research/organization/research-institutes-and-centres/accl/index.aspx). For helpful comments on an earlier draft, the authors are indebted to prof. Prue Vines, UNSW Law School, Sydney.